Identifying GSW entry/exit wounds?

[Para-Medic]

Hi everyone,

I remember we had a discussion about this is class about identifying which is the entry/exit GSW. Besides asking the patient or any witnesses how would you identify it? From what I have heard the exit wound is sometimes (or usually) the largest gap while the entry is small. Still, our instructor told us he has seen some GSW where the entry wound was bigger than the exit and vise versa. So I wanted to know if you all know how to properly identify them. Also, would identifying them change or influence the care of the patient (either BLS or ALS)? If yes, how? Just curious on these sort of things. If anyone has any advice please post. THANKS

[PRPGfirerescuetech]

Hi everyone,

I remember we had a discussion about this is class about identifying which is the entry/exit GSW. Besides asking the patient or any witnesses how would you identify it? From what I have heard the exit wound is sometimes (or usually) the largest gap while the entry is small. Still, our instructor told us he has seen some GSW where the entry wound was bigger than the exit and vise versa. So I wanted to know if you all know how to properly identify them. Also, would identifying them change or influence the care of the patient (either BLS or ALS)? If yes, how? Just curious on these sort of things. If anyone has any advice please post. THANKS

In my opinion, dont try to identify it. To be honest, you open yourself for a liability by doing so.

In forensics, bullet direction, and specifically location of entry or exit can be intrinsic in an investigation, and can (and is) used as evidence in homicide investigations. Problem is, what if your wrong? Do you really want to testify something is a entry, when its an exit? You then can turn an investigation simply because of a personal lack of information.

No matter entry or exit, i dont believe care changes. It is a wound, regardless of where it came from. Treat as such.

[ERDoc]

We once had the ME lecture to us about crime scenes and pts that come from them. He said that we should never try to identify which is which, as posted before it may hurt the case if there is conflicting info. He said just describe the wound (ie a 2 inch hole in the right side of the head). It should not change your management. If you add up the number of holes, it should be an even number, or else there is still a bullet inside.

[jules1977]

Entry?EXit...like what was said who cares...But I think that generally the exit will be bigger. Think of what a bullet does. You could have multiple points of entry...that is shotgun. I had one recently and there was a couple inch diameter of small pellet wounds in the front, nothing too dramatic. However his back had a huge gaping hole. As for Tx, just go! There is nothing definitive that you can do in serious cases. The person needs a surgeon and all you can do is ABC's. The more time you spend on the scene the longer it is too surgery. Always think 5 or less, if it can be done.

[paramedicmike]

I've seen exit wounds smaller than entry. I've seen entry wounds smaller than exit. Unless you are trained to identify such injuries, you should not, under ANY circumstances, make any effort to identify what is an entry or exit wound. As was noted, if you misidentify what type of wound it is, you could throw an entire case against a suspect off. What's worse, you could be responsible for letting the guilty party get away with murder.

Please do not make any attempt to identify or document which is the entry or exit wound in a patient with a GSW. You're not trained to do it. As such, you don't know how to do it. In other words, don't do it!

ERDoc presents a good way to document the noted injuries.

Yeah...don't do it.

-be safe.

[AZCEP]

Definitely keep your description as simple as possible.

If you only see one hole, well that must be the entry. If you see two, describe them as penetrating injuries and where they are located.

If they have a hole, plug it. If they need a hole, make it.

[Ridryder 911]

Ditto.. remember skin stretches.. so one can not make a determination without proper education.. and like others states, it does not really matter.

Be safe,

R/R 911

[AnatomyChick]

Yep... I agree with all of the above posts... our job is to treat the patient... doesn't matter entrance / exit, what matters is how the patient is doing.

[Dustdevil]

Pathologists are still fighting over whether JFK's wounds were entry or exit, 43 years after the fact.

Obviously, it is not an exact science. Interesting? Sure, but don't get too caught up in it when it really doesn't make any difference.

[Eydawn]

Plug the holes, treat the symptoms... you don't have to know which direction the holes came from, because only a surgeon can fix the internal damage. Plug, load and go, trauma is a surgical disease!

Wendy

NREMT-B